The Down Low
The Down Low is a 6th season episode of House that first aired on January 11, 2010. House and Wilson have a crush on their new neighbor and they compete for her attention. However, their plans are complicated by a misunderstanding by their new neighbours about the nature of their relationship. A drug dealer mysteriously collapses during a sale and does it again whenever there is a loud noise. Chase, Thirteen and Taub play a practical joke on Foreman. Recap During a drug deal, Mickey, collapses after a gun shot, but he's not wounded - another participant took the bullet in the foot. The downed dealer's partner, Eddie, tries to revive him, but Mickey remains unconscious. Mickey goes to Princeton-Plainsboro Teaching Hospital and the emergency room refers him to House to get him away from the police in the emergency room. House soon figures out that the patient was near a gun shot. The dealer and Eddie get up to leave, but House warns them it will happen again. To make his point, he slams his cane against the table and Mickey collapses again. House brings the case to his team - the patient has vertigo induced by loud noises. His CT Scan is clean and there is no internal bleeding or edema. The patient is not disclosing any information about himself. Thirteen figures out that House is intrigued. Foreman thinks it is acoustic neuroma, but House thinks the drugs were tainted. He orders Foreman to do the test and he goes to get a cocaine sample. Meanwhile, Wilson is flirting with his new neighbour Nora. She agrees to see them if he agrees to bring House along because she thinks they are a gay couple. Wilson denies it, but Nora is skeptical. They prepare the patient for the acoustic test. Foreman has found a pay stub showing that Thirteen's middle name is Beauregarde, but he thinks it's a fake because the amount is too high. However, Taub says he makes that much too. He realizes Foreman makes less. House goes to Eddie and asks him for the cocaine, but he refuses to admit they deal drugs. Instead, they start talking in code by talking about textiles. Eddie insists Mickey never uses the product. Wilson comes in and tells House everyone at the condo thinks they are gay. House is not surprised and is unconcerned. However, Wilson wants to ask out Nora and he can't wait for her to learn the truth. The other dealer says the patient hates drugs and is worried about how long the test is taking. However, it's only an ear test so House says he will be fine. However, the patient suffers a severe seizure during the test and his blood pressure shoots so high they are afraid he will have a stroke. Foreman remarks that at least his hearing tested fine. The patient is put on vasodilators. They start a new differential and House orders an ultrasound to see if his arteries are clogged. Foreman finds out from Thirteen she makes more that he does and he goes to confront Cuddy about making less than everyone else. However, Cuddy turns him down flat. The ultrasound was normal, and when the team returns they find out that House has bugged the room to get more information about the patient. However, he can‘t get it to work. He thinks there are toxins in the patient’s fat cells. He tells Taub to tell the patient they will need weeks to test him to get him out of the hospital so they can get a proper medical history. When Taub follows instructions, the patient insists on being released as planned. However, Chase and Thirteen follow the patient when he leaves the hospital. They discuss how they're lying to Foreman about how much money they make to make fun of him and knock him down a few pegs. Thirteen runs a red light to keep up with the patient, but the police pull her over. House meets Nora at the mailbox and tells her they are both straight, but then he starts acting like he's gay by displaying a poster of "A Chorus Line" and complimenting her shoes. Foreman tells Taub he's going to wait for his salary review, and Taub says he would do the same thing, but that's because he's weak. The patient comes back to the hospital because he's suffering from a severe fever - 105F, and he starts getting very disoriented. They give the patient anti-pyretics and steroids and his fever went down and he was no longer delirious. House has figured out that the rest of the team has convinced Foreman he makes less they do and wants to join the fun. He orders a lumbar puncture to look for infections. The patient tells Chase that he knew he was being followed but had business to do. When Chase reminds him that he's a drug dealer, the patient point out that they probably get more patients with alcohol issues than illegal drug issues. Chase notices that although the patient's heart rate should be elevated during the procedure, it's normal. Wilson confronts House about having an "Evita" listening party with Nora. House tells him that Nora didn't believe they were straight when she told him. House's plan is to keep playing gay until he convinces Nora that she's the only women who has ever made him feel straight. Wilson calls dibs on her because he saw her first, but House says he only called dibs because he knows he's going to lose. Chase comes back to tell House that the lumbar puncture was clean, but the regular heart rate could show an autonomic nervous disorder. However, House goes to see the patient and accuses him of taking beta blockers to keep him from suffering the stress of his illegal lifestyle. He admits took one the night before he collapsed and when he came to the hospital, he was in withdrawal, which accounted for his high blood pressure. When he left the hospital, he took another and his blood pressure went back down. Chase thinks it might be excess adrenaline from a pheochromocytoma. House orders a scan of his adrenal glands. Wilson comes home to see House giving Nora a neck rub. Wilson decides to ruin House's fun by sitting down for dinner. Taub and Foreman are discussing Foreman's negotiating strategy with Cuddy. Foreman bluffed about having a better job offer. However, it didn't work and Foreman says he's going to leave when the case is over. Wilson is still trying to convince Nora he's not gay. He tells her House is trying to sleep with her, and she accuses him of being jealous. The MRI was clear, meaning the stress was just normal stress. Thirteen has figured out how the bug is supposed to work, but she's not having any better luck. However, when House realizes the bug can’t find an open frequency, he has an idea - he goes to the patient’s room and asks Eddie to leave. He asks about the beta blockers again, which only relieve the symptoms of stress, and why he didn't chose something to actually treat the stress, like Valium. He searches the room and finds out why his bug wasn't working - there were two bugs in the room. Mickey is an undercover police officer. House tells the rest of the team about the patient being a police officer. He sends Chase and Thirteen to confront him. However, the patient says they still don't know who he is and he's not giving up on his operation because they are close to an arrest. He tells them just to keep him alive until then, at which point he will disclose everything. When Eddie comes back, the patient has an infarction from a clot in his digestive tract. They do surgery to remove part of the small intestine. The new symptoms appear to point to an environmental cause. Foreman wants to treat him, but Thirteen points out that treating him for all the possibilities could kill him. She suggests that the patient is holding out for a good reason, but if any of his other friends had the same symptoms, they may be a little more selfish. Thirteen brings Eddie a coffee and tells him the patient will recover from surgery. She asks him where they have been. He refuses to say, but then starts feeling woozy. However, Eddie realizes Thirteen drugged him and still holds out. However, he does realize the patient could die, and agrees to take Thirteen to where they‘ve been keeping the drugs. They go to a dry cleaner's and Thirteen starts testing. However, while they are there, they hear someone else there. Thirteen pretends to be a prostitute to allay suspicion and the other person leaves. House goes to dinner with Nora and they discuss Wilson's “jealously issues“. House plays right into it by saying he can't go back to his apartment. Nora agrees to let him stay over at her place. However, Wilson drops by the restaurant and says out loud that he loves House and he's not going to deny it any more. He proposes marriage. House is, for once, caught off guard, although the other patrons in the restaurant urge him to say yes. Nora realizes that House and Wilson need to discuss it and leaves. The tests on most of the samples are negative, but they haven't tested the dry cleaning chemicals, which appear to be the culprit. Thirteen, Taub and Chase discuss how their plan blew up and made Foreman leave. They talk about whether they should beg Foreman to stay or to beg Cuddy to let Foreman come back. Foreman comes in and says the albuterol they were giving the patient isn't working and he's started to cough up blood. However, Thirteen has finally tested the dry cleaning chemicals. Instead of using the more common perchloroethelene, they were using petroleum solvents - a much safer and environmentally friendly alternative. This means the dry cleaner was a dead end and they have no explanation for the patient bleeding into his lungs. They do a VQ scan which shows a pulmonary aneurysm, which explains the blood. However, a later scan done that morning shows three more aneurysms. This would indicate a fungal infection. House accused Thirteen of missing something at the dry cleaner, but she points out that if it were a fungus, the steroids they gave him would mean he should have ten times as many aneurysms by now. Foreman still wants to start him on anti-fungals and House agrees. They start the patient on the medication, but he is still coughing up blood. The patient tells Eddie he was stupid for taking Thirteen to the dry cleaners because he could have been shot. However, the friend says he had to so something and that the patient would do the same for him. The friend then goes to leave to meet the person the patient is hoping will be arrested. The friend promises to return the next day to see him. The patient apologizes for not being able to go with him. Taub, Chase and Thirteen go to Cuddy to tell her that their prank with Foreman got out of control and that's why he kept asking for more money. However, Cuddy refuses to give Foreman a raise. They agree to each take a pay cut so that she can, and Cuddy agrees. However, she then discloses Foreman hasn't come to see her in three days and she has no idea what they were talking about. They find Foreman outside of Cuddy's office and he says, "The phrase 'Who's Your Daddy!' comes to mind". Nora comes to see House at his office. He once again tells Nora that they aren't gay and he was trying to get to touch her breasts. She starts to leave, but then he tells her that Wilson is a really good guy. However, when she's still mad, he also tells her about Wilson's three divorces. When he mentions that Wilson only looks like a boy scout, he thinks of something and leaves the room. The patient is still throwing up blood. House comes in and tells him that they've been wrong to this point. The aneurysms are inflammatory and aren't the result of a fungal infection. The high blood pressure was a real symptom - the beta blockers were just masking it. He has Hughes-Stovin syndrome, an autoimmune disease. As it's in its advanced stages, there is nothing they can do to treat it. He has less than a day to live. Thirteen informs him that even if he had been up front at the beginning, they probably could not have saved him. The patient asks to call his wife. The patient's wife arrives in time before he dies. The drug bust goes down as scheduled. Wilson and House discuss the patient's death. Wilson ran into Nora again, who now thinks they are both "dirtbags". House is happy the charade is over because he can get rid of the A Chorus Line poster, but Wilson says he likes it. He starts singing from the show and says he will only stop if House agrees to get rid of the ugly (but cheap) couch he bought. Once Wilson starts singing, House threatens to punch him in the face. Wilson demands House get rid of the ugly (but cheap) couch. "No chance", House says. Unsurprisingly, Wilson keeps on singing much to House's dismay. Zebra Factor 8/10 Hughes-Stovin syndrome is very rare. Reviews *TV.com users rated the episode an 8.6. They chose Sasha Alexander as the "Most Valuable Performer" in the episode *Polite Dissent panned the medicine in the episode, giving the medical mystery a C, the final solution a D, and the medicine a D. Hoewver, he liked the story lines and gave those an A. *IMDB users rated the episode an 8.8 with 47.8% rating it a 10. Trivia & Cultural References *“The Down Low” has multiple slang meanings in this episode: **It can refer to criminal activity that must be kept secret. **It is also used in the gay African-American community to refer to closeted homosexual activity. *A Chorus Line is a successful Broadway musical about a group of dancers who are auditioning for a position on the chorus line of a big show. “One”, which Wilson sings at the end, is the best known song from the show. *Jack Bauer was the main protagonist in the TV series 24 which was produced for the Fox Network from 2001 through 2010. He frequently used intense means of interrogation, which usually worked. *Evita is another Broadway musical by Andrew Lloyd Webber and Tim Rice about the life of Eva Perón. *House and Nora are watching The Real Housewives of Atlanta *Kung Pao Chicken is a Sichuan Chinese dish of Chicken mixed with hot chilies, peanuts and vegetables. *Someone took the time to try to track down what game between the Detroit Red Wings and the Toronto Maple Leafs House and Wilson were watching at the end of the episode. Their conclusion was that the 3-2 score in favor of the Leafs at the end of the second period ruled out any possible game between those two opponents, particularly since the Wings were wearing their white home jerseys. There was a 2003 game where the Leafs were ahead 3-2 at the end of the 2nd period, but that game was played in Toronto and the Wings would have been wearing their red road jerseys. There was a 2008 game in Detroit where the Leafs led 3-2, but that was in the third period. *Some excellent Holmesian conclusions in this episode: **House figures out how the patient got injured by looking at his injuries **When House realizes that another electronic listening device is interfering with his electronic listening device, he realizes that only a police officer would be bugging the room and the patient must be one. *Chase has a new haircut in this episode Goofs Polite Dissent, a blog that covers the medicine on House, M.D. was probably more critical of this episode than any other in the series and pointed out many problems: *Although Hughes-Stovin can be fatal when the aneurysms start rupturing, there are still available treatments, so the patient could have been saved even with the late diagnosis, In addition, if they had diagnosed it and given him steroids when he first came in, it is very likely that treatment would have been successful. *The timeline of when the aneurysms appear is greatly accellerated. They develop over long periods of time, not overnight. *Hughes-Stovin causes thrombosis in the veins, not the arteries. *Pheochromocytomas usually appear on the adrenal glands, but in up to 20% of cases, they do not. As such, a clean scan of the adrenals is suggestive in ruling it out, but doesn't mean it should have been eliminated. *The superior mesenteric artery supplies most of the small intestine with blood. If it were blocked, a patient would lost most of the intestine, not just a foot or so. *A patient collapsing when hearing a loud noise doesn't really describe vertigo. A patient with noise-induced vertigo would be more likely to get dizzy and slowly lose their balance, not just drop like a stone. Sudden collapse is more correctly described as catalepsy. *Lots of things can cause seizures, so House's conclusion that it must have been high blood pressure is a bit of a jump to a conclusion. For example, lidocaine toxicity, which was a differential, would also explain a seizure. *Foreman jammed an object into the patient's mouth when the patient had a seizure. Although that might be appropriate for a board certified neurologist in 1910, in 2010 it's clearly malpractice. *Expecting to see improvement on anti-fungals in a few hours is hopelessly optimistic. A patient on antibiotics may not improve in a few hours and fungus is far far harder to kill than bacteria because bacteria grow quickly, but fungus grows slowly. *If you take enough beta-blockers to block pain, you will be bradycardic with a heart rate of under 60. *Although coming off high blood pressure medication can cause rebound high blood pressure, that's not a common problem with beta-blockers, and it's very unlikely the blood pressure would rise high enough to cause a seizure. *VQ scans are great at finding the cause of coughing up blood and finding a pulmonary embolism, but doesn't really show aneurysms. *The VQ scan they are looking at is way too clear. It's probably a CT Scan. *Inhaled medications like Albuterol are unlikely to treat a systemic problem. Music *''Sway ''by Dean Martin (at the restaurant during House and Nora's dinner) *''Maggot Brain ''by Funkadelic (during the drug deal) *''One, ''from ''A Chorus Line ''(at the end of the episode, first by Wilson, then by the original Broaday cast as the episode fades out) Quotes Cast *Hugh Laurie as Gregory House *Lisa Edelstein as Lisa Cuddy *Omar Epps as Eric Foreman *Robert Sean Leonard as James Wilson *Jennifer Morrison as Allison Cameron (credit only) *Jesse Spencer as Robert Chase *Peter Jacobson as Chris Taub *Olivia Wilde as Remy Hadley *Ethan Embry as Mickey *Sasha Alexander as Nora *Nick Chinlund as Eddie *Paul Zies as Marco *Preson James Hillier as Tommy *Sean Carrigan as Guy *Rosalie Vega as Nurse Yvette *Sherry Weston as Diner *Bonnie Kathleen Ryan as Mickey's Wife *Sammy Busby as Gorski *Bobbin Bergstrom as Nurse Release Dates *United States - January 11, 2010 on FOX *Canada - January 11, 2010 on Global *Australia - April 25, 2010 *Israel - August 11, 2010 on HOT3 *Hungary - September 7, 2010 *Czech Republic - October 6, 2010 on TV Nova *Germany - October 12, 2010 on RTL *Poland - November 18, 2010 on TVP2 *Slovakia - November 30, 2010 on STV1 *Sweden - March 1, 2011 on TV4 *Japan - September 20, 2011 In Other Languages Links * Episode summary at TV.com * Episode article at Wikipedia﻿ * A review of the medicine at Polite Dissent * Episode article at IMDB * Episode article at HouseMD Guide Video thumb|300px|left|Episode preview thumb|left|300px|Second preview thumb|300px|left|Short preview Category:Episodes Category:Season 6 Category:Episodes ending in the patient's death